PubMed · 11659620
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John M Naber, David R Johnson. Mandatory HIV testing issues in state newborn screening programs.. https://pubmed.ncbi.nlm.nih.gov/11659620/
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OBJECTIVE: To estimate HIV incidence density for different exposure categories among people undergoing repeat testing in Ontario, Canada. METHODS: Persons using voluntary, diagnostic HIV testing at least twice were identified by computerized and manual record linkage. In the 1992-2000 period, 980 seroconverters and 340 994 repeat negative testers contributed 936 145 person years (PY) of observation. Incidence density (ID) was calculated according to Kitayaporn et al. Poisson regression was used to evaluate differences in incidence. RESULTS: Among men who have sex with men (MSM), ID declined between 1992-1996, from 1.23 per 100 PY in 1992 to 0.79 per 100 PY in 1996 [relative risk (RR), 0.86 per year; 95% confidence interval (CI), 0.77-0.96]. Subsequently, ID increased to 1.39 per 100 PY in 1999 (RR, 1.18 per year; 95% CI, 1.05-1.34). In 2000, ID was 1.16 per 100 PY but this decrease was not statistically significantly different from 1999. MSM in their twenties had the highest ID in 1992-1996, but in 1996-2000 MSM in their thirties had the highest risk of infection. Among injecting drug users (IDU), ID decreased from 0.64 per 100 PY in 1992 to 0.14 per 100 PY in 2000 (RR, 0.87 per year; 95% CI, 0.80-0.94). Among heterosexuals, annual incidence remained constant at about 0.03 per 100 PY in 1992-2000. CONCLUSIONS: Increases in ID were identified among MSM from 1996 to 1999. These findings are consistent with other research. Continued vigilance and improved surveillance are needed to better understand and control the epidemic.
Voluntary HIV counseling and testing (VCT) is a central component of comprehensive HIV prevention strategies targeting individual risk reduction. VCT data are essential for planning and improving HIV/AIDS intervention strategies. The objective of this study is to describe demographic profiles, reasons for seeking HIV counseling and testing, rate of declining HIV testing after pretest counseling, rate of failure to return for HIV test results, and HIV prevalence and associations among 3570 clients who sought VCT at Sansai Hospital in northern Thailand from 1995 to 1999. Data were abstracted retrospectively from client-level data recorded by the hospital counselors on a standard form. HIV prevalence was 29% and remained high throughout the study period. Reasons for seeking VCT for men and women were markedly different and highly correlated with rates of declining the test, failure to return for test results, and HIV prevalence. Declining VCT and failing to return were high among uneducated clients (p <.001). Failure to return among men was associated with HIV prevalence (OR = 1.72, p =.003), particularly for those who had risk behaviors (OR = 5.92, p <.001) and those who wanted to know their HIV serostatus (OR = 4.44, p =.002). Overall, VCT acceptance and returning for test results were high. VCT services at the community level can reach high-risk individuals, especially male partners of women tested as part of routine prenatal care.
OBJECTIVE: To document HIV prevalence/incidence trends from 1995-2000 and associated risk factors among injection drug users (IDUs) in Eastern Central Canada as an indication of harm reduction strategy effectiveness. METHODS: Nonnominal cross-sectional data (one-time participants) and longitudinal data (repeat participants) were collected using convenience sampling. Participants provided informed consent for face-to-face interviews focused on injection drug use and sexual practices during the previous 6 months; oral fluid samples were taken for HIV testing by enzyme immunoassay. Unique encrypted codes for initially HIV-negative repeat participants permitted incidence rate calculations. RESULTS: In all, 6387 IDUs (median age, 31 years; range, 13-67; males, 73.5%) participated on 9724 occasions. HIV prevalence ranged from 4.7% (95% confidence interval [CI], 2.9-6.5) in semiurban areas to 20.1% (95% CI, 17.6-22.7) in Ottawa, Ontario. HIV incidence was 6.0 (95%CI, 4.5-7.6) per 100 person-years (py) in Montréal, Québec, 3.2 (95% CI, 2.2-4.2) per 100 py in Québec City and 7.0 (95% CI, 4.1-9.8) per 100 py in Ottawa/Hull. Reusing other IDUs' needles was reported by 38.4%. In multivariate logistic regression, IDUs injecting for 6 or more years were more likely to be HIV positive, particularly if cocaine was the predominant drug injected. Multivariate Cox regression revealed higher HIV incidence among those who predominantly injected cocaine, reused others' needles, had injected 6 years or more, injected with strangers, or were men reporting commercial sex work. CONCLUSIONS: These results reveal a volatile situation of continuing HIV transmission among IDUs in Eastern Central Canada.